Dr. holemon- Medical Management of ED
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Dr. Holemon, M.D. spoke at the Castlewood Preferred Provider Conference on the medical aspects of the treatment of Eating Disorder.
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Alcohol misuse can cause social, psychological, and physical problems. It is implicated in 40% of road traffic accidents, 50% of murders, and 80% of suicides. Safe alcohol limits are 14 units per week for men and women, with 2 alcohol-free days, and no more than 3 units in a day. Alcohol intoxication, withdrawal, and dependence are classified. Withdrawal symptoms range from mild to life-threatening. Long-term effects include depression, suicide, hallucinations, and alcohol-related dementia. Treatment focuses on managing withdrawal and preventing relapse using medications, rehabilitation programs, and support groups.
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This document provides information on alcohol, its effects on the body, alcohol dependence and withdrawal, and treatment approaches. It discusses how alcohol acts in the brain to produce both pleasurable and reinforcing effects. It outlines recommended daily and weekly drinking limits, signs and symptoms of alcohol intoxication at different blood alcohol levels. It also summarizes common presentations to the emergency department related to alcohol, approaches to assessing and managing alcohol withdrawal, risks of Wernicke's encephalopathy from thiamine deficiency, and options for ongoing treatment and support.
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- Treatment involves medication like antidepressants, psychotherapy, and lifestyle changes. Proper treatment
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Mr. XYZ, age 39, presented with tremors, vomiting blood, seizures, and confusion. He has a history of alcohol dependence and multiple relapses. On examination, he was confused, tachycardic, and jaundiced. Lab tests showed elevated liver enzymes. He was diagnosed with delirium tremens during acute alcohol withdrawal. He was treated with benzodiazepines, thiamine, and other supportive care. Benzodiazepines are the primary treatment for alcohol withdrawal to prevent progression to severe withdrawal states like delirium tremens and seizures.
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Altered mental status is one of the most challenging situations EMS faces. Mental status provides important clues about brain perfusion and oxygenation. Common causes of altered mental status include respiratory compromise, trauma, toxins, hypoperfusion, and metabolic or structural disorders of the brain. Proper assessment of altered mental status requires evaluating the patient's airway, breathing, circulation, neurological status, glucose levels, and looking for signs of potential toxic ingestions, infections, trauma or other treatable conditions. Treatment may involve giving naloxone or glucose while stabilizing the patient's airway, breathing and circulation before identifying the underlying cause.
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This document defines and describes substance-related disorders and the main categories of substances that can cause them. It notes that substance use disorders include abuse and dependence, while substance-induced disorders involve intoxication, withdrawal, and mental states induced by the substance. It then provides details on depressants, stimulants, and hallucinogens - the main classes of substances that can cause these disorders. It defines each category and provides examples of substances that fall within them, along with their effects and medical/recreational uses.
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Dr. Sujit Kumar Kar discusses depression, including its causes, symptoms, diagnosis and treatment. Some key points include:
- Depression is one of the most common psychiatric illnesses worldwide, affecting people of all ages, races and genders. It causes significant psychological distress and reduces quality of life.
- Symptoms include sadness, loss of interest, low energy, changes in appetite or sleep, feelings of worthlessness, difficulty concentrating and recurrent thoughts of death.
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- Treatment involves medication like antidepressants, psychotherapy, and lifestyle changes. Proper treatment
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This document provides an overview of depression, including its definition, types, epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, investigations, and treatment. Depression is defined as a common mental disorder characterized by depressed mood, loss of interest, feelings of guilt, sleep disturbances, low energy, and poor concentration. Major types include major depressive disorder, bipolar disorder, dysthymic disorder, and situational depression. Depression affects over 350 million people globally and is a leading cause of disability. Causes may include genetic, environmental, biochemical and neurological factors. Treatment involves antidepressant medications like SSRIs, TCAs, and MAOIs as well as psychotherapy and other non-pharmacological approaches.
Recent advances in Eating disorder
aneroxia nervosa, bulemia nervosa , binge eating , diet, overeating , obesity , treatment psychotherapy .
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Symptom management
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Subtopics: introduction, clinical feature, DSM 5, Differential diagnosis, treatment, etiology.
presented in American University of Barbados.
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I would do the following:
1. Assess for delirium by checking vital signs, mental status, and reviewing the medication list for any recent changes.
2. Taper and discontinue the ropinirole and alprazolam which can worsen hallucinations.
3. Consider reducing the levodopa dose gradually if hallucinations persist after stopping the other medications.
4. Initiate a trial of quetiapine or clozapine which are less likely to worsen parkinsonism compared to other antipsychotics. Start low and titrate slowly.
5. Reassure the patient and family that the hallucinations are likely due to Parkinson's disease progression and
Similar to Dr. holemon- Medical Management of ED (20)
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- 1. Medical Management of Eating Disorder Dr. Dawn Holemon
- 2. Diagnostic Assessment • Psychiatric • Anorexia nervosa • Bulimia nervosa • ED, nos • Medical • Risk increased with rapid weight change, purging, onset of binges, non compliance with medication
- 3. AN, BN or ED, nos • Refer for inpatient or residential care Pregnancy Diabetes mellitus Abnormal EKG Deficiencies of potassium, magnesium or phosphorus Suicidal ideation
- 4. EKG
- 6. Associated disorders • Psychiatric Major depression Anxiety disorder Bipolar disorder Alcohol and/or drug dependence or abuse Body dysmorphic disorder
- 7. Laboratory tests commonly indicated in eating disorder Liver enzymes RBC Folate Blood count Magnesium, Serum creatinine, Phosphorus, Amylase, ferritin, vitamin B12 Potassium, Sodium TSH
- 8. Laboratory tests commonly indicated in eating disorder Urinalysis Urine drug screen EKG Bone density
- 9. Medical complications of eating disorder Edema Weakness Shortness of breath Cardiac arrhythmias Chest pain Confusion Loss of consciousness
- 10. Medical complications of eating disorder Refeeding syndrome -imbalance of electrolytes and fluid -risk factors -symptoms to monitor
- 11. Psychotropic medications used to treat eating disorder SSRI Other antidepressant SNRI Trimonoamine TCA modulator MAOI
- 12. Psychotropic medications used to treat eating disorder Mood stabilizers Antipsychotics, 1st generation Antipsychotics, 2nd generation
- 13. Psychotropic medications used to treat eating disorder Anxiolytics, non benzodiazepine Benzodiazepines, short-acting Benzodiazepines, mid-acting Benzodiazepines, long-acting
- 14. Psychotropic medications used to treat eating disorder Insomnia ADHD Dependence, opioid Dependence, nicotine
- 15. Common side effects of medications used to treat eating disorder Lightheadedness Headache Sedation Acid reflux Dry mouth nausea Constipation
- 16. Less common side effects of medication used to treat eating disorder Parasthesia EPSE Weight gain/loss Galactorrhea
- 17. Recent research in neuropsychiatry
Editor's Notes
- Diagnosis of ED; anorexia, bulimia or ED, nos Concurrent psychiatric diagnosis, history of prior treatment, medications, onset of illness Medical; preadmission labs, EKG, bone density; ROS, past medical history, FH Cardiac arrhythmia is the most common medical cause of death in AN
- Chest pain, dysrhythmias, syncope
- Strength of association of substance use disorders varies by diagnosis, strongest in bulimia, weaker in ED of AN, purging type, not significant in AN, restricting Substance use increased suicide risk across the board, all psychiatric diagnoses
- Refeeding at low energy replacement and monitor electrolytes, weight, cardiac status Rapid weight loss and/or profound weight loss; abnormal EKG; low phosphorus levels Symptoms; swelling, SOB, altered mental status
- SNRI examples TCA uses MAOI issues and complications Other antidepressant examples TMM example; deplin or methylfolate as booster